A Fayetteville VA Insider Describes the Mess
The information for this story was provided by a Patient/Primary Care Provider (PCP) who works at the Fayetteville VA Medical Center, North Carolina. This person wishes to remain anonymous for fear of retaliation; she saw what happened to a colleague who contacted the IG’s office. This patient/primary care provider contacted me years prior to the scandals made public in Phoenix, to describe her disappointment working for a corrupt system. I wrote this to share her frustration, but she wants ”the cockroaches exposed” for the veteran’s sake.
My source who is also a trusted old friend, has described to me the typical patient she sees most often; a heavy smoker, with lung disease, diabetic, high blood pressure and non-compliant with their medications. Further, they often have complicated histories including liver disease, sometimes HIV positive with substance abuse and rapidly declining health. Treating one problem endangers another medical issue making careful management essential.
The VA medical care providers must work with a computer program called the” Patient Aligned Care Team (PACT),” a concept designed by behavioral health specialists. PACT can be described as a patient centered program, but in reality it places very high demands on the PCP and robs needed time from the patient. PACT produces numbers that can be used to make supervisors and administrators look good.
The patients at the Fayetteville VAMC often are not assigned to a PCP because on the books it looks much better to show a PCP (a Doctor, a Nurse Practitioner, or a Physician Assistant) with few patients assigned to them for care. In reality, it is overloaded to 1200, plus the unassigned. This camouflages the real situation – quote “a game played so well by admin here.” Another trick they play is to reassign patients to other care givers when staff leaves. No one is hired to fill the vacancies, thus money is saved and the bosses look good. Gilbert Baez of TV station WRAL documented the long waits veterans must endure.
If the patient shows up on time for an average 30 minute appointment, vital signs are first taken by a care team member. While this is happening, the PCP must scan through all of the patient’s medical documentation to gain some knowledge of the patient they will be seeing. The patient will more often than not, have a very complicated medical history and a full range of complaints, and only 20 minutes face to face with the medical provider. That provider, who hardly knows the patient, must make many decisions for their health and safety.
Computerized medical records are the direction being taken for modern medicine, but a demanding computer system that takes even more time away from the PCP and the patient? As the doctor attends to the patient, he/she enters basic documentation in to the computer, but more and more pop-ups appear asking for further information. The provider is forced to explore and document unnecessary information while losing time for the patient. If the doctor does not complete the information they can be reprimanded or worse.
To illustrate this; as an appointment starts, the doctor asks the patient to describe why they are seeking medical help, a computer widow pops up asking if the patient is a smoker. If the answer is yes, then more windows pop up to be answered. The provider, despite their own schooling and experience, is shackled by a computer program while gathering numbers for bean counters. Our doctor is seeing a patient for a leg infection and reeks of cigarette smoke, yet the provider must spend precious time documenting that the patient is a smoker, how many cigarettes per day, for how long, and do they want to quit. The time needed for the patient’s infection has been lost. Common sense is not in play and the patient’s problem is not really the focus.
Have these problems in the Fayetteville VA Hospital been shared with chiefs of patient care, such as Dr. Briones, Chatterjee, Morehouse, Komandur, Williams, and Cummings? Yes many times - without resolution for their subordinates or patients. As my friend described,” numbers are more important than people.”
The source for this article described how the administrators are the only ones getting bonuses, while they are the cause of the problems. Patient Care Providers are further burdened by administration with lack of administrative time to answer important communications, attend mandated 2 -6 hour long online-classes, or respond to patients medication refill requests. All this extra work placed on the people who see patients is not rewarded - only impeded.
The Fayetteville administration is aware of these chronic problems and ignores them. These problems have been brought to their attention by many and often. The hospital’s admin does not even use a very important tool when staff resigns – the exit interview. This would seem just plain dumb but the administration may not want to hear about what they are doing wrong, over and over again. Administrative staff appears to be favored over the care givers - only they receive bonuses, retaliate against others, and ignore serious issues when presented. The fact that clerical staff can walk around in public wearing large gold necklaces expressing political views show something is seriously wrong.
Administrators are the means in which any machine they manage is lubricated. If the product is poor or the machine is broke - then the bosses have failed and should be held accountable. The director of the Fayetteville VA hospital is described as mostly focused on giving happy-horse shows at pep rallies. Thinking about the ineptness at Fayetteville and all that has been exposed recently in the news, one must come to the realization that the top bosses in the VA medical system are focused on their careers, the numbers, and their friends. Patients and those who take care of them are a distraction in their work day. All those posters vets see in the hallways demonstrate their hypocrisy. In the end the veteran suffers again.
Thank God I go to the Seattle VAMC and the employees are happy.
Reader responses are welcomed.